Mental Health Institute Rivierduinen, GGZ Rivierduinen, Sandifortdreef 19, 2333 ZZ, Leiden, The Netherlands.
School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands.
BMC Psychiatry. 2023 Nov 27;23(1):878. doi: 10.1186/s12888-023-05374-8.
Based on clinical experience, a (hypothetical) four-type model of suicidality that differentiates between subtypes with a unique pathway to entrapment ((h)4ME)was developed. The subtypes are: 1) perceptual disintegration (PD), 2) primary depressive cognition (PDC), 3) psychosocial turmoil (PT) and 4) inadequate communication/coping (IC). This study was carried out to examine the usability and feasibility of the subtypes in an absolute and dimensional way with the SUICIDI-2 instrument.
A first step was to examine the model and the SUICIDI-2 instrument for usability and feasibility in clinical practice. We aim to investigate the'real life' practical application of the model and hope the feedback we get after practical use of the model will help us with improvements for the model and the SUICIDI-2 instrument.
Discharge letters to general practitioners of 25 cases of anonymized suicidal emergency patients were independently reviewed by three psychiatrists and three nurses. Using the SUICIDI-2 instrument, describing the proposed subtypes, cases were classified by the psychiatrists and nurses. Intraclass Correlation Coefficients (ICC) for absolute/discrete and dimensional ratings were calculated to examine the model's usability and the instrument's feasibility. The study was approved by the ethical board.
All raters were able to recognize and classify the cases in subtypes. We found an average measure of good reliability for absolute/(discrete) subtypes. For dimensional scores, we found excellent average measures for the subtype PDC, and good average measures for the subtypes PD, PT and IC. The reliability of dimensional score for the SUICIDI-2 was relatively lower than an alternative dimensional rating, but had good ICC values for all subtypes. After reviewing the results though, we found some inconsistently assessment between raters. This was ground to narrow down the criteria per subtype to describe the subtypes more precisely. This resulted in adjusted formulations for subtypes PD and IC and agreement was achieved about formulations in the revised SUICIDI-3.
The hypothetical model of entrapment leading to suicidality shows promising results for both the usability and feasibility of the SUICIDI instrument. Follow up studies with participants with a more diverse background may show consistency and validity for the model.
基于临床经验，开发了一种（假设的）自杀倾向四型模式，该模式区分了具有独特陷入途径的亚型（h）4ME。这些亚型包括：1）感知解体（PD），2）原发性抑郁认知（PDC），3）心理社会动荡（PT）和 4）沟通/应对不足（IC）。本研究旨在通过 SUICIDI-2 工具以绝对和维度的方式检查亚型的可用性和可行性。
第一步是检查模型和 SUICIDI-2 工具在临床实践中的可用性和可行性。我们旨在研究该模型在“现实生活”中的实际应用，并希望在实际使用模型后收到的反馈将有助于我们改进模型和 SUICIDI-2 工具。
将 25 例匿名自杀急诊患者的出院信由三名精神科医生和三名护士独立审查。使用 SUICIDI-2 工具，描述所提出的亚型，由精神科医生和护士对病例进行分类。计算绝对/离散和维度评分的组内相关系数（ICC），以检查模型的可用性和工具的可行性。该研究已获得伦理委员会的批准。
所有评估者都能够识别和分类病例的亚型。我们发现，绝对/（离散）亚型的可靠性测量平均值良好。对于维度评分，我们发现 PDC 亚型的平均指标非常好，PD、PT 和 IC 亚型的平均指标也很好。SUICIDI-2 的维度评分可靠性相对低于替代维度评分，但所有亚型的 ICC 值都很好。但是，在审查结果后，我们发现评估者之间的评估存在一些不一致。这促使我们为每个亚型缩小标准，以更准确地描述亚型。这导致了 PD 和 IC 亚型的调整表述，并就修订后的 SUICIDI-3 达成了表述一致。
导致自杀倾向的假设陷阱模型显示出 SUICIDI 工具的可用性和可行性有很好的结果。具有更多元背景的参与者的后续研究可能会为该模型提供一致性和有效性。
